X-rays alone may not always spot a fracture

US doctors from Duke University warn that relying on standard x-rays alone could lead to a mis-diagnosis.

The x-ray results of 92 patients were re-checked by the researchers using a MRI – a more detailed scanner, they found 35 fractures that had been missed.

Lead researcher, Dr Charles Spritzer said: “The diagnosis of traumatic fracture most often begins and ends with x-rays of the hip, pelvis or both.

“In some cases though, the exclusion of a traumatic fracture is diffciult.”

When studying patients complaining of pain after an injury to the hip or pelvis, researchers found that 13 of them who had normal x-ray findings were found to have a collective total of 23 fractures seen on the MRI.

The researchers say it is worth using MRI as well as an x-ray, particularly since hip patients tend to be frail and elderly with a higher risk of complications.

“Accurate diagnosis of hip and pelvic fractures in the emergency department can speed patients to surgical management, if needed, and reduce the rate of hospital admissions among patients who do not have fractures.

“Use of MRI in patients with a strong clinical suspicion of traumatic injury but unimpressive X-rays has a substantial advantage in the detection of pelvic and hip fractures,” said Dr Spritzer.

Dr Tony Nichlson, from the Royal College of Radiologists, said the findings quantified something already suspected, but did not think it would be feasible to give every patient an MRI scan.

“Ultimately, it comes down to clinical acumen. If an elderly patient has a persistent pain even though their X-ray shows only minor arthiritis, an MRI would be a very reasonable request to check that there is not a fracture.

“It is always worrying when something is not diagnosed immediately, but I think most clinicians are first class and would follow up a patient appropriately.”

By Deepika Dudakia